
        <br>
        <div>
            <form name="client" method="post" action="UpdateClient.php">
                <table id="form" align="center" cellspacing="1"cellpadding="0">
                    <tr class="col_head">
                        <td colspan="2">&nbsp;</td>
                        <td><h1>Client's details</h1></td>
                        <td><h1>Other applicant (if any)</h1></td>
                    </tr>
                    <tr>
                        <td width="15%" align="right">Title:</td>
                        <td width="1%">&nbsp;</td>
                        <td width="40%">
                            <select name="title1" id="title1">
                                <option value="0" <?php if($title == "") echo "selected=selected"; ?> >Title</option>
                                <option value="Mr" <?php if($title == "Mr") echo "selected=selected"; ?> >Mr</option>
                                <option value="Mrs" <?php if($title == "Mrs") echo "selected=selected"; ?> >Mrs</option>
                                <option value="Miss" <?php if($title == "Miss") echo "selected=selected"; ?> >Miss</option>
                                <option value="Ms" <?php if($title == "Ms") echo "selected=selected"; ?> >Ms</option>
                                <option value="Dr" <?php if($title == "Dr") echo "selected=selected"; ?> >Dr</option>
                            </select> 
                            
                        </td>
                        <td width="40%">
                            <select name="title2" id="title2">
                                <option value="0">Title</option>
                                <option value="mr">Mr</option>
                                <option value="mrs">Mrs</option>
                                <option value="miss">Miss</option>
                                <option value="ms">Ms</option>
                                <option value="dr">Dr</option>
                            </select> 
                        </td>
                    </tr>
                    <tr>
                        <td align="right">First Names:</td>
                        <td>&nbsp;</td>
                        <td>
                            <input name="fname1" type="text" size="50" id="fname1" value="<?PHP print $first_name ?>"/></td>
                        <td>
                            <input name="fname2" type="text" size="50" id="fname2" /></td>
                    </tr>
                    <tr>
                        <td align="right">Last Name:</td>
                        <td>&nbsp;</td>
                        <td>
                            <input name="lname1" type="text" size="50" id="lname1" value="<?PHP print $last_name ?>"/></td>
                        <td>
                            <input name="lname2" type="text" size="50" id="lname2" /></td>
                    </tr>
                    <tr>
                        <td align="right">Telephone:</td>
                        <td>&nbsp;</td>
                        <td>
                            <input name="telno1" type="text" id="telno1" value="<?PHP print $telno ?>"/></td>
                        <td>
                            <input name="telno2" type="text" id="telno2" /></td>
                    </tr>
                    <tr>
                        <td align="right">Email:</td>
                        <td>&nbsp;</td>
                        <td>
                            <input name="email1" size="50" type="text" id="email1" value="<?PHP print $email ?>"/></td>
                        <td>
                            <input name="email2" size="50" type="text" id="email2" /></td>
                    </tr>
                    <tr>
                        <td colspan="2">&nbsp;</td>
                        <td>Current Address</td>
                        <td></td>
                    </tr>
                    <tr>
                        <td align="right">House No./Name</td>
                        <td>&nbsp;</td>
                         <td>
                            <input name="house" type="text" id="house" value="<?PHP print $house ?>"/></td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td align="right">Street</td>
                        <td>&nbsp;</td>
                         <td>
                            <input name="street" size="50" type="text" id="street" value="<?PHP print $street ?>"/></td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td align="right">Town/City</td>
                        <td>&nbsp;</td>
                         <td>
                            <input name="town" size="50" type="text" id="town" value="<?PHP print $town ?>"/></td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td align="right">County</td>
                        <td>&nbsp;</td>
                         <td>
                            <input name="county" size="50" type="text" id="county" value="<?PHP print $county ?>"/></td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td align="right">Postcode</td>
                        <td>&nbsp;</td>
                         <td>
                            <input name="postcode" size="8" type="text" id="postcode" value="<?PHP print $postcode ?>"/></td>
                        <td>&nbsp;</td>
                    </tr>
                    <tr>
                        <td colspan="2"></td><td><br><input id="btnsubmit" name="btnsubmit" type="submit" value="Submit" onClick="return(valid(document.frmclaim.txttele));" />
                        </td>
                    </tr> 
                </table>
            </form>
        </div>